Let’s Learn About Mental Health Parity

All right students, take out your textbooks and turn to page 42, “learning about mental health parity.”

Enough already with the moaning and groaning.  This is an important topic.

Did you know, for example, that “the vast majority of Americans” know nothing about mental health parity?  According to Dr. Gregory Fritz of Brown University, “They are neither ‘for’ nor ‘against’ it – they just don’t think about it.”

Dr. Fritz also says that mental health advocates have a “huge educational task” before them and that the first step is to “educate ourselves.”

So let’s get on with it!  Let’s learn about mental health parity.

The word “parity” means “the state or condition of being equal, especially in status or pay.”  When we talk about “mental health parity” we are highlighting efforts to treat mental health with the same dignity and importance as physical health.

Sounds simple, right?  Unfortunately, for centuries people didn’t think mental health was equal to physical health.  Even in the 20th Century, “It’s all in your head” and “get a grip” were responses given to men and women seeking help for mental illness.  The stigma was so painful that most people feared to seek help.

It’s been a long, hard struggle to bring mental illness out of the shadows.

Less than twenty years ago the first Mental Health Parity Act was passed by the United States Congress.  The MHPA required insurers to provide mental health benefits no lower than the annual and lifetime benefits they accorded to physical health.

It was a good first step, but essentially toothless.  Like today, most patients didn’t know about the law.  Doctors, hospitals and insurers found ways to get around it.  The law itself didn’t actually mandate mental health coverage.  Insurers could simply by-pass the Act by not offering it.  The Act didn’t cover substance abuse treatment, because – even in 1996 – most Americans viewed substance abuse as a moral, not a physical, failure.

Then, in 2008, Congress passed the Mental Health Parity and Addiction Equity Act.  Once again, the MHPAEA did not mandate mental health coverage.  And, once again, the MHPAEA was stymied, this time by regulatory agencies that delayed interpretive rulings until late 2013.  However, for the first time, substance abuse disorders were included.

By 2013 the MHPAEA had already been superseded by passage of the Affordable Care Act (aka Obamacare).  Under the ACA, mental health is one of ten “Essential Health Benefits” (EHBs).  The ACA mandates equal coverage for mental health, substance abuse disorders and eating disorders.

Yes, that’s right Jonah.  Mental health parity is now the law of the land.

Is the fight over?  Doctors report there are not enough psychologists, counselors and therapists to meet the increased need for mental health services.  Along with the law, we need a greatly expanded mental health infrastructure.  In addition, the stigma of mental illness and substance abuse disorders continues to keep patients from seeking treatment.

Even with these challenges, we’re at an historic crossroads in the history of mental health.  Dr. Fritz says, “We are seeing the greatest increase in mental health treatment in a generation,” affecting some 62 million people.

Students, that’s all the time we have for this session on Mental Health Parity.

But before you go, remember this:  you can help.  Tell your friends, family, classmates, and the community that it is okay to seek medical help for mental illness, substance abuse disorders and eating disorders.  Not only are these diseases curable in many cases, the law says they should be treated the same way doctors treat a broken arm, a skin rash or the flu.

Thanks for your attention.  Class dismissed!!

Coping with Anxiety

I had my first panic attack in seventh grade, while taking a science test. One minute, I was scribbling an answer to an essay question. The next minute, my heart was pounding, my skin was clammy, and I felt dizzy and numb. My teacher sent me to the nurse’s office, and I made up the test the next day. It wasn’t until several years and a dozen panic attacks later that I understood my symptoms as a physical experience of anxiety.

Anxiety – an uncomfortable feeling of fear or concern – is a common and normal human experience. In fact, anxiety is beneficial when it keeps us from taking unnecessary risks or motivates us to prepare for a challenge. But anxiety becomes a problem when it interferes with daily life. Chronic worry, avoidance behaviors, and frequent panic attacks can all be symptoms of problematic anxiety.

Fortunately, people of all ages can learn to manage anxiety. The remainder of this post will offer tips on coping with anxiety, followed by a discussion of when and how to ask for help.

Managing Anxiety

The following suggestions for managing anxiety are adapted from the Anxiety and Depression Association of America website:

  • Take a break. Practice deep breathing, learn a relaxation technique, pray or meditate, listen to music, enjoy nature, read a book, write in a journal. Try something that calms you and gives you time away from your problem.
  • Take care of your physical self. Get enough sleep and exercise. Fuel your body with healthy foods. Avoid caffeine and sugar.
  • Adjust your outlook. Have realistic expectations. Aim for good, not perfect. Accept that you can’t control everything. Try replacing negative thoughts with positive. Embrace humor.
  • Learn what triggers your anxiety. Prepare for challenges instead of avoiding them. Facing your fears takes away their power.
  • Building healthy relationships. Find a group activity you enjoy. Help others and let them help you. Share your feelings with someone you trust.

When and How to Ask for Professional Help

Sometimes individual coping strategies are not enough. The National Institute of Mental Health estimates that about 8 percent of teens have diagnosable anxiety disorders and could benefit from treatment. Individuals with untreated anxiety disorders are at increased risk for depression, substance abuse, disordered eating, and other issues. (For example, I learned to cope with my panic attacks while in treatment for depression.) Anxiety treatment has a high rate of success and can include therapy, medication, or both. According to the American Psychological Association, the following are signs that it’s time to ask for help:

  • You experience extreme fear or worry that does not let up.
  • Anxiety is interfering with your daily life.
  • You have trouble concentrating because of your worries.
  • You have frequent panic attacks.
  • You often avoid situations due to unrealistic fears.
  • You repeatedly perform routines or rituals to try to rid yourself of anxiety.

A parent, school counselor, or other trusted adult can support you in seeking professional help for anxiety. You can also find support and links to resources through NAMI Washington, Psychology Today’s therapist directory, or King County’s Teen Link help line (1-866-833-6546).

To meet some real teens who have received successful treatment for anxiety, watch “Worried Sick: Living with Anxiety,” a 22-minute video produced for Nick News.


American Psychological Association

Anxiety and Depression Association of America

National Institute of Mental Health

Addiction: A disease or bad behaviors

When chatting with the kids I work with in treatment about the healthy results recovery affords us, I often joke with them that I have 21 years clean and sober and have not been arrested in, let’s see, 21 years. Must be just an odd coincidence.

All jokes aside I can easily appreciate why folks still have such difficulty understanding Substance Use Disorders as a disease rather than a function of poor choices or even character or morality. Let’s look at a few of the factors that may contribute to this difficulty.

I think one that is glaringly apparent regards our culture’s connection to the idea of personal choice. It makes sense that this American ideal would contradict the loss of control a chemically dependent individual experiences as we do not “drink responsibly” as the ad suggests. So powerful is this notion in fact that many of us with this healthcare condition blame ourselves and struggle with significant guilt over our actions while in active addiction.

Another factor is simply statistical. The majority of folks never develop any difficulty with substance use and cannot imagine how someone would not have the ability to control their own behaviors.

Finally, and let’s be honest, quite early on in the progression of this disease an individual begins violating their own system of values and acts in a manner contradictory to commonly held social and legal standards the majority adhere to. Sadly I am the one ruining a good friend’s wedding, picking the kids up after a few too many, or passing out at the birthday party. I am the one who is “super nice” as long as I am not drinking. The list just goes on and folks whisper “why would he keep doing that?”, yet no one waits for the answer.

Well here it is.

To transcend the common misconceptions related to Substance Use Disorders we have to understand their nature. Some individuals simply have a response to substances that is anomalous or exceptional. Think about a bell curve. No healthcare condition effects everyone. This unique response is usually a function of a genetic predisposition and it subsequently begins the ever increasing compulsion and obsession to use substances in spite of sometimes catastrophic consequences in order to maintain the pleasurable reward response. As time goes on my central nervous system is just unable to keep me in balance neurologically and so continued drug use becomes the only option for general comfort or even survival.

Imagine being hungry, having not eaten for days. What lengths might you go to in order to satisfy this need? Now multiply that by hundreds! This is the “why” if you will. Executive [brain] functions (Prefrontal Cortex) simply do not have the ability to override the primal necessity created in the reward pleasure center (Nucleus Accumbens). Human beings are designed like this. Primitive systems such as pain, or flight/fright are designed to take precedence. As such, I do not “want” to use a substance, I “need” to use. This combined with tissue dependence leaves a biological system that only functions normally in the presence of a drug.

This does not mean I am not accountable for my actions as I am solely responsible for my health in recovery and the amends I need to make. It simply means I am not a bad person needing to get good, but rather an individual with a healthcare condition that needs to be managed into remission.